Important Note: Since this form is forwarded to each child's caseworker, you must submit a separate form for each child or sibling group you are interested in. Please allow 30 days for caseworkers to contact you regarding your inquiry

While not all of these fields are required, we encourage you to complete this form with as much detail as possible. The more information you provide, the better equipped the caseworker is to make decisions about matches.

Note: Please do not include special characters in your responses (i.e. * + = | or "" ).
Including any special characters may interfere with your inquiry being submitted correctly.

Child Desired

Important Note: Since this form is forwarded to each child's
caseworker, you must submit a separate form for each child or
sibling group you are interested in.

Question -
Not Required -Is there a specific
child you are interested in?

Question -
Not Required -Name:

Question -
Not Required -State:

Question -
Not Required - Child ID #:

Applicant Information

*

Name:

Title

First Required

Last Required

Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City
Required

State Required

ZIP Required

*

Country: Required

*

Phone Number: Required

Occupation:

Gender:

*

Date of Birth: Required

Date of
Birth:

Month

Day

Year

Yes, I would
like to receive email from The Adoption Exchange.
*Please note that opting out will exclude you from Event
Updates.

Yes, I would like to receive postal mail from
The Adoption Exchange

Question -
Not Required -Applicant Ethnicity:

Question -
Not Required -Applicant
Religion:

Question -
Not Required -County:

Marriage Information

*

Question -
Required -Marital
Status:

Question -
Not Required -Date Married
(mm/dd/yyyy):

Question -
Not Required -Applicant #2 First
Name:

Question -
Not Required -Applicant #2 Last
Name:

Question - Not Required
-Applicant #2 Gender:MaleFemale

Question -
Not Required -Applicant #2
Ethnicity:

Question -
Not Required -Applicant #2
Religion:

Question -
Not Required -Applicant #2
Email:

Family Information

The information requested below is very important to each
caseworker. Please be sure to select or provide answers and
information thoroughly in each drop-down box and text field below
on each inquiry you submit.

Note:It may be useful for you to type up your
response in a word processing application and using Ctrl + C to
copy and Ctrl + V to paste the text in the field
below.

Comments:

Question -
Not Required -Comments may include
your parenting experience, experience with children like this
child, family strengths, interests, and any adoption training. Also
include anything you would like this child's caseworker to know
about you. Each of these inquiries is forwarded to the child's
caseworker. You may have made a number of inquiries; please be
aware that each inquiry may be going to a different caseworker, so
you need to fill out this box each time. (Helpful hint: store your
comments for caseworkers in a word document, then cut and paste
into this box.) Please limit your comments to 300 words or less
(the size of the comments window).

Question - Not
Required -Information
Desired:

Adoption of a healthy
infant or a child from another
country

Adoption of an older
child from foster care (waiting child or child
with special needs)

Weekly Waiting Child
Emails

Information provided in this form will be entered into our
database and may be forwarded to caseworkers and/or agencies as a
potential match for other children.